American Indian Persons' Perspectives on Various Smoking Cessation Aids and Approaches: A Community-Engaged Qualitative Research Study.

Introduction: Increasing smoking cessation among American Indian (AI) persons is a critical equity goal.

Aims and methods: During 2022, AI persons (N = 46) were interviewed on perceptions of existing and novel cessation approaches. Intention to use each approach was assessed and questions started with "cold turkey" and then queried about the following: nicotine patches, gum, lozenges (NRT); prescription medications; plant-based medications; personalized medicine; e-cigarettes; and nicotine reduction standard (NRS).

Results: Perspectives informed the identification of six crosscutting themes which were (a) environmental constraints, (b) addictiveness and side effects, (c) effectiveness of approach, (d) interpersonal influence, (e) duration or requirements of approach, and (f) novelty. Plant-based medications were viewed as natural, less likely to cause side effects, and aligned with AI cultures. Regarding NRT, many participants talked about positive word-of-mouth but noted concerns about effectiveness, side effects, and price. Regarding personalized medicine, many indicated curiosity, but some noted it would delay treatment and was too extreme to share a sample. Common perspectives for cold turkey were its drug-free nature and cost savings, but some noted it does not address cravings. Regarding the NRS, many were supportive, although some were concerned with compensatory smoking and what else remains in the cigarettes.

Conclusions: Themes translated to the greatest proportion of participants stating they would use plant-based medications followed by NRT and personalized medicine. Fewer participants reported intent to use prescription medications and e-cigarettes which reflect greater concerns with these approaches.

Implications: Results can inform tribal and other public health programming and communication efforts to increase smoking cessation among AI persons and help drive down disparities.